| Objective: To compare the efficacy of liver transplantation(LT)and liver resection(LR)in patients with hepatocellular carcinoma(HCC)within Milan Criteria(MC)and three subgroups: solitary 0-3 cm,multiple 0-3 cm and solitary 3-5 cm and to explore the independent risk factors of recurrence and survival in HCC patients within MC and in HCC patients with MVI.We explored the independent risk factors of microvascular invasion(MVI)in HCC,constructed preoperative prediction model of MVI and compared the efficacy of LT and LR in HCC patients with MVI,which provided evidence-based medicine for optimizing the clinical treatment decision of HCC patients within MC.Methods: Between July 2009 and May 2016,a total of 519 patients(270 for LT and 249 for LR)with a first presentation of HCC from two medical centers were retrospectively screened.The clinical data,histopathological data and follow-up data of the patients were collected.The data were analyzed with R 3.6.2 version.We performed the analysis of recurrence,HCC-specific survival(HSS)and overall survival(OS)between LT and LR with Kaplan-Meier estimators and log-rank tests before/after inverse probability of treatment weighting(IPTW).LASSO COX regression analysis was used to explore the independent risk factors of recurrence and survival.We explored the independent risk factors of MVI and established the preoperative prediction model of MVI by LASSO Logistic regression analysis.Results: Among HCC patients,the ratio of male to female was 5.57:1,with an average age of 53.35 ±9.60 years.The median follow-up period was 68.70 months,with 156 patients recurred(30.06%)and 116 patients died(22.35%).There were little differences in recurrence,HSS and OS of LT and LR between before IPTW and after IPTW.After IPTW,the 5-year recurrence(16.33% vs 61.62%),HSS(88.54% vs 55.08%),OS(83.60% vs 55.08%)of LT were better than LR.In solitary 0-3 cm,the 5-year recurrence(5.76% vs 33.32%),HSS(95.52% vs 86.11%)of LT were better than LR,and the 5-year OS showed no significant difference with LR(88.32% vs 86.11%).In multiple 0-3 cm,the 5-year recurrence(16.56% vs 87.98%),HSS(94.11% vs 18.96%),OS(88.40% vs 18.96%)of LT were better than LR.In solitary 3-5 cm,the 5-year recurrence(29.45% vs 60.85%)of LT was better than LR,the 5-year HSS(74.12% vs 64.78%),OS(72.71% vs 64.78%)of LT showed no significant differences with LR.Multivariate COX regression analysis showed that treatment,ALBI grade,portal hypertension(PH),glutamyl transpeptidase(GGT),platelet,tumor number,tumor size and MVI were independent risk factors of recurrence,and treatment,sex,GGT,tumor number and MVI were independent risk factors of HSS and OS.Multivariate Logistic regression analysis showed that BCLC stage,alpha-fetoprotein(AFP)and GGT were independent risk factors of MVI,and the C-index of nomogram was 0.685.In HCC patients with MVI,multivariate COX regression analysis showed that treatment,PH,tumor number were independent risk factors of recurrence,and treatment,PH,platelet,GGT,tumor number were independent risk factors of HSS,and gender,PH,tumor number were independent risk factors of OS.After IPTW,the 5-year recurrence(9.04% vs 38.09%),HSS(93.83% vs 76.54%)of LT were better than LR,and the 5-year OS of LT showed no significant difference with LR(83.88% vs 76.54%).Conclusion: BCLC stage,AFP and GGT are independent risk factors of MVI in HCC.For HCC patients with MVI,treatment(LT or LR),PH,tumor number are independent risk factors of recurrence,and treatment(LT or LR),PH,platelet,GGT,tumor number are independent risk factors of HSS.LT and LR are both effective treatments for HCC patients within MC,and LT shows better long-term prognosis than LR.For HCC patients with MVI,LT manifests better 5-year recurrence and HSS than LR,and shows similar 5-year OS than LR. |
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